Incisional hernia after continuous barbed versus interrupted non-barbed sutures for midline fascial closure in minimally invasive colorectal cancer surgery: a propensity score-matched analysis.

PURPOSE: Incisional hernia (IH) is a common complication of abdominal surgery, and the optimal suture technique for midline fascial closure remains controversial. This study compared continuous barbed sutures with interrupted non-barbed sutures in patients who underwent minimally invasive colorectal cancer surgery.

METHODS

We retrospectively evaluated 299 patients who underwent laparoscopic or robotic radical colorectal resection between 2020 and 2023. Of these, 228 who underwent a small midline umbilical incision were included. Fascial closure was performed using either continuous barbed absorbable sutures (n = 60) or interrupted non-barbed absorbable sutures (n = 162). Propensity score matching (PSM) was performed at a 1:1 ratio, yielding 51 matched pairs for comparison. Primary outcome was IH incidence as confirmed by computed tomography or physical examination. Secondary outcomes focused on infectious complications as well as postoperative morbidity, mortality, and hospital stay.

RESULTS

After PSM, the incidence of IH was significantly lower in the continuous barbed group than that in the interrupted non-barbed group (7.8% vs. 33.3%, P = 0.001). In non-obese patients (Body mass index < 25), barbed closure reduced the IH incidence (2.7% vs. 23.5%, P = 0.006). In obese patients, the difference was not statistically significant (21.4% vs. 52.9%, P = 0.07), likely reflecting limited power. Although ileus was more frequent in the interrupted non-barbed group (7.8% vs. 0%, P = 0.02), infectious complications were comparable between groups. Multivariable analysis identified interrupted non-barbed sutures and obesity as independent risk factors for IH.

CONCLUSIONS

Continuous barbed fascial closure was associated with a significantly lower IH incidence after minimally invasive colorectal cancer surgery without increasing infectious complications. These findings support the effectiveness of a barbed-continuous closure strategy for midline extraction incisions.